Treatment Option Overview
- Topical corticosteroids.
- Topical chemotherapy with mechlorethamine (nitrogen mustard) or carmustine (BCNU).
- Psoralen and ultraviolet A radiation (PUVA).
- Ultraviolet B radiation (UVB).
- Total-skin electron-beam radiation (TSEB).
- Radiation of symptomatic skin lesions.
- Interferon-alpha or interferon-gamma alone or in combination with topical therapy.
- Single-agent and multiagent chemotherapy.
- Bexarotene (topical gel or oral); retinoids.
- Denileukin diftitox (recombinant fusion protein of diphtheria toxin fragments and interleukin-2 sequences).
- Vorinostat or romidepsin or other histone deacetylase inhibitors.
- Pralatrexate (folate analog).
- Alemtuzumab (a humanized monoclonal antibody targeting the CD52 antigen).
- Combined modality treatment.
These types of treatments produce remissions, but long-term remissions are uncommon. Treatment, therefore, is considered palliative for most patients, though major symptomatic improvement is regularly achieved. Survival in excess of 8 years, however, is common for patients with early stages of disease. All patients with MF/SS are candidates for clinical trials evaluating new approaches to treatment.
Current areas of interest in clinical trials for MF confined to the skin include combined modality therapies containing both topical and systemic agents such as TSEB combined with chemotherapy, topical mechlorethamine or PUVA combined with interferon, or wide-field radiation techniques with PUVA. Reports are available of activity for extracorporeal photochemotherapy using psoralen; interferon-gamma or interferon-alpha; pentostatin; retinoids; fludarabine; acyclovir; 2-chlorodeoxyadenosine; serotherapy with unlabeled, toxin-labeled, or radiolabeled monoclonal antibodies; cell surface receptor ligand-toxin fusion protein; and, methotrexate.[3,5-14] Antigen-specific vaccination using dendritic cells  and UVB are also under clinical evaluation.
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